Koo D, Traverso H, Libel M, Drasbek C, Tauxe R, Brandling-Bennett D
The Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Bull Pan Am Health Organ. 1996 Jun;30(2):134-43.
This report presents the various cholera case definitions used by the affected countries of Latin America, shows the numbers of cholera cases and deaths attributable to cholera (as reported by Latin American countries to PAHO through 1993), and describes some regional trends in cholera incidence. The information about how cholera cases were defined was obtained from an October 1993 PAHO questionnaire. In all, 948429 cholera cases were reported to PAHO by affected Latin American countries from January 1991 through December 1993, the highest annual incidences being registered in Peru (1991 and 1992) and Guatemala (1993). The case-fatality rate over the three-year period, and also in 1993, was 0.8%. A general downward trend in the incidence of cholera was observed in most South American countries, while the incidence increased in most Central American countries. A good deal of variation was noted in the definitions used for reporting cholera cases, hospitalized cholera cases, and cholera-attributable deaths. Because of these variations, broad intercountry comparisons (including disease burden calculations and care quality assessments based on case-fatality rates) are difficult to make, and even reported trends within a single country need to be evaluated with care. The situation is likely to be complicated in the future by the arrival of V. cholerae O139 in Latin America, creating a need to distinguish between it and the prevailing O1 strain. For purposes of simplicity, wide acceptance, and broad dissemination of case data, the following definitions are recommended: Confirmed case of O1 cholera: laboratory-confirmed infection with toxigenic V. cholerae O1 in any person who has diarrhea. Confirmed case of O139 cholera: laboratory-confirmed infection with toxigenic V. cholerae O139 in any person who has diarrhea. Clinical case of cholera: acute watery diarrhea in a person over 5 years old who is seeking treatment. Death attributable to cholera: death within one week of the onset of diarrhea in a person with confirmed or clinically defined cholera. Hospitalized patient with cholera:a person who has confirmed or clinically defined cholera and who remains at least 12 hours in a health care facility for treatment of the disease.
本报告介绍了拉丁美洲受灾国家使用的各种霍乱病例定义,展示了霍乱病例数以及霍乱所致死亡人数(截至1993年拉丁美洲国家向泛美卫生组织报告的数据),并描述了霍乱发病率的一些区域趋势。关于霍乱病例定义的信息来自1993年10月泛美卫生组织的调查问卷。1991年1月至1993年12月期间,受灾的拉丁美洲国家共向泛美卫生组织报告了948429例霍乱病例,秘鲁(1991年和1992年)和危地马拉(1993年)的年发病率最高。三年期间以及1993年的病死率均为0.8%。大多数南美洲国家的霍乱发病率呈总体下降趋势,而大多数中美洲国家的发病率有所上升。在报告霍乱病例、住院霍乱病例和霍乱所致死亡的定义方面存在很大差异。由于这些差异,很难进行广泛的国家间比较(包括疾病负担计算和基于病死率的医疗质量评估),甚至对单个国家内报告的趋势也需要谨慎评估。未来,霍乱弧菌O139传入拉丁美洲可能会使情况变得复杂,需要将其与流行的O1菌株区分开来。为了简单起见、便于广泛接受和传播病例数据,建议采用以下定义:O1霍乱确诊病例:任何腹泻者经实验室确诊感染产毒霍乱弧菌O1。O139霍乱确诊病例:任何腹泻者经实验室确诊感染产毒霍乱弧菌O139。霍乱临床病例:5岁以上寻求治疗的急性水样腹泻患者。霍乱所致死亡:确诊或临床诊断为霍乱的患者在腹泻发作后一周内死亡。住院霍乱患者:确诊或临床诊断为霍乱且在医疗机构接受该疾病治疗至少12小时的患者。